A Grant Proposal for PHC6534: Building Resilience and Providing Culturally Appropriate Mental Health Services to Southeast Asian Refugee and Immigrant Families

Hello everyone, as part of my graduate coursework, I've written a grant proposal that proposes a trauma-informed public health intervention for providing culturally appropriate mental health services for the Southeast Asian American community in Long Beach, California. Below, I give an overview of my grant and discuss applicable trauma-informed principles, levels of the social-ecological model, and public health framework.

Overview
Southeast Asian American (SEAA) communities in the United States face a unique set of circumstances as they have experienced traumatic life experiences pre- and post-resettlement due to the Vietnam War. SEAA life experiences encompass war-related trauma (e.g., political persecution, starvation, witnessing executions, and kidnappings) and challenging resettlement experiences in the U.S. (e.g., poverty, crime, and violence). [1] Such challenging post-resettlement experiences were driven by several factors, including the unpopularity of the Vietnam War in the U.S. and the lack of culturally appropriate services where SEAs resettled. [2] [3]

The accumulation of these traumatizing life experiences among the SEAA community has perpetuated poorer health outcomes and manifest through the mechanisms such as ACEs and intergenerational trauma. [2-5] Current literature finds that SEA individuals who reported more severe trauma are also more likely to report poorer physical (i.e., increased risk for type 2 diabetes, chronic pain, and cardiovascular diseases) [2-4] and mental health outcomes (i.e., post-traumatic stress disorder, anxiety, adjustment disorders, and clinical depression). [2] [3] Finally, current literature also calls on the need for more culturally appropriate mental health services to improve the overall health of the SEA population. [1-7]

The target audience of this intervention includes individuals who are at least 18 years or older from SEAA refugee and immigrant families and are residents of Long Beach, California, to participate in receiving mental health services, regardless of health insurance status. Our intervention will also work with locally established SEAA organizations to identify SEAA community leaders and mental health professionals to provide culturally appropriate mental services.

This grant aims to fund several project activities. The first is to establish a community advisory board of SEAA community leaders and mental health professionals to hold regular community meetings to learn about the specific mental health needs of the Long Beach SEAA community. The second and third project activities comprise training SEAA community leaders and mental health professionals to provide trauma-informed care and other mental health services. This project will require all staff, community leaders, and mental health professionals to complete training and certification in trauma-informed care.

All project activities aim to: (1) learn and understand how daily stressors contribute to the experiences of the Long beach SEAA community; (2) improve the cultural competence of SEAA community leaders and mental health professionals; (3) increase engagement of the SEAA community in mental health and wellness behaviors; and (4) to increase civic participation, collaboration, and advocacy among all Long Beach SEAA stakeholders.

Public Health Framework
This intervention aims to prevent and address trauma at the primary, secondary, and tertiary levels of prevention. [8] Primary level activities include educating all stakeholders about the impacts of trauma and intergenerational trauma in the SEAA community. Secondary level activities include training all staff and community leaders to screen and refer community members to the appropriate mental health services. Tertiary prevention activities consist of delivering culturally sensitive and competent services by local community organizations and mental health professionals.

Levels of the Social-Ecological Model
This intervention uses McLeroy's Social-Ecological Model [9] to guide project activities, goals, outcomes, and prevention strategies.

At the intrapersonal level, SEAA community members, SEAA community leaders, and mental health professionals will learn about SEAA culture, improve self-efficacy [10] of seeking and referring services, and gain knowledge about peer support and counseling services. At the interpersonal level, informal and formal social networks developed due to community meetings and activities will promote healthier communication styles and improve peer relationships. [10] At the organizational level, community meetings and trauma-informed care training will improve trust and rapport within the community and increase the number and quality of culturally appropriate resources available to the SEAA community. Finally, at the community level, the gained cultural competence among stakeholders will encourage health-promoting behaviors such as seeking mental health services. [9] [10]

Trauma-Informed Principles
This intervention directly incorporates four trauma-informed principles. The principle of trustworthiness and transparency and the principle of collaboration and mutuality [11] are achieved through the regularly held community meetings where participants have the opportunity to voice their concerns, ideas, and feedback about the program's direction. The principle of peer support [11] [12] is achieved by forming peer support networks in both informal and formal settings. All participants will have the ability to share and learn from one another's lived experiences. Such networks may promote healing and growth within the community. Finally, the principle of cultural, historical, and gender issues [11] is also addressed through regularly held community meetings. All SEAA participants and stakeholders will learn about the unique trauma experiences of the SEAA community and better understand how to communicate with the SEAA community.

Please feel free to post any questions, comments, or feedback you may have for my grant proposal. Thanks for reading!

References

1. Southeast Asia Resource Action Center. (2020). Southeast Asian American Journeys. Southeast Asia Resource Action Center. https://www.searac.org/wp-cont..._PrinterFriendly.pdf
2. Wagner, J., Burke, G., Kuoch, T., Scully, M., Armeli, S., & Rajan, T. V. (2013). Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut. Journal of immigrant and minority health, 15(6), 1065–1072. https://doi.org/10.1007/s10903-012-9715-2
3. Hsu, E., Davies, C. A., & Hansen, D. J. (2004). Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges. Faculty Publications, Department of Psychology, 86. https://digitalcommons.unl.edu/psychfacpub/86.
4. Wong, E. C., Marshall, G. N., Schell, T. L., Elliott, M. N., Babey, S. H., & Hambarsoomians, K. (2011). The unusually poor physical health status of Cambodian refugees two decades after resettlement. Journal of immigrant and minority health, 13(5), 876–882. https://doi.org/10.1007/s10903-010-9392-y
5. Ta, K., Westermeyer, J., & Neider, J. (1996). Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders. Psychiatric services (Washington, D.C.), 47(9), 975–979. https://doi.org/10.1176/ps.47.9.975
6. Lee, S., Juon, H.-S., Martinez, G., Hsu, C. E., Robinson, E. S., Bawa, J., & Ma, G. X. (2009). Model minority at risk: Expressed needs of mental health by Asian American young adults. Journal of Community Health, 34(2), 144–152. PubMed. https://doi.org/10.1007/s10900-008-9137-1
7. Southeast Asia Resource Action Center. (2020). Southeast Asian American Journeys. Southeast Asia Resource Action Center. https://www.searac.org/wp-cont..._PrinterFriendly.pdf
8. Feuer-Edwards, A., O'Brien, C., & O'Conner, S. (2016). Trauma-Informed Philanthropy: A funder's resource guide for supporting trauma-informed practice in the Delaware Valley. Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, United Way of Greater Philadelphia and Southern New Jersey. https://philanthropynetwork.or...raumaGUIDE_Final.pdf
9. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
10. Golden, S. D., & Earp, J. A. L. (2012). Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions. Health Education & Behavior, 39(3), 364–372. https://doi.org/10.1177/1090198111418634
11. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (HHS Publication No. (SMA) 14-4884). Substance Abuse Mental Health Services Administration, U.S. Department of Health and Human Services. https://ncsacw.samhsa.gov/user...es/SAMHSA_Trauma.pdf
12. Shalaby, R., & Agyapong, V. (2020). Peer Support in Mental Health: Literature Review. JMIR mental health, 7(6), e15572. https://doi.org/10.2196/15572